MEDICARE: KENNETH C. DAHLIN, O.D., PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1353	WA

General Provider Information

NPI Number	:	1407803356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH C. DAHLIN, O.D., PLLC

Provider Business Mailing Address
First Line	:	4502 S STEELE ST
Second Line	:	SUITE 304-B
City	:	TACOMA
State	:	WA
Zip	:	98409-7242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 S STEELE ST
Second Line	:	SUITE 304-B
City	:	TACOMA
State	:	WA
Zip	:	98409-7242
Country	:	US
Telephone Number	:	253-472-6465
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH DAHLIN
Credential	:
Telephone Number	:	253-472-6465

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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